Implant OcclusionImplant OcclusionSummary Based onSummary Based on

Occlusion for implant-supported fixed dental prostheses in partially Occlusion for implant-supported fixed dental prostheses in partially edentulous patients: a literature review and current conceptsedentulous patients: a literature review and current conceptsJudy Chia-Chun YuanJudy Chia-Chun Yuan**, Cortino Sukotjo, Cortino Sukotjo

Department of Restorative Dentistry, University of Illinois at Chicago College of Dentistry, Chicago, IL, USADepartment of Restorative Dentistry, University of Illinois at Chicago College of Dentistry, Chicago, IL, USA

• Periodontal Periodontal Ligament act Ligament act as Shock as Shock AbsorberAbsorber

• Axial Mobility Axial Mobility 25 to 100 25 to 100 μmμm

• Lateral Lateral Loading - Loading - Forces Forces dissipated dissipated apicallyapically

• Occlusal Occlusal Overload - Overload - widening of widening of the PDL, the PDL, Fremitus, Fremitus, and mobility and mobility of the toothof the tooth

• No Periodontal No Periodontal Ligament Ligament

• Axial Axial Displacement Displacement 3 to 5μm3 to 5μm

• Lateral Lateral Loading - Loading - Forces Forces concentrated concentrated at the crestalat the crestal

• Occlusal Occlusal Overload - Overload - Inflammation, Inflammation, Crater-like Crater-like Bone Defect, Bone Defect, Screw Screw Loosening, Loosening, Fracture of the Fracture of the Screw/AbutmeScrew/Abutment/Prosthesis/Int/Prosthesis/Implantmplant

Implant Occlusal Implant Occlusal SchemeScheme

• Flat Fossa and Grooves for wide freedom in centricFlat Fossa and Grooves for wide freedom in centric

• Shallow Occlusal AnatomyShallow Occlusal Anatomy

• Narrow Occlusal Table - 30% to 40% smaller for molars Narrow Occlusal Table - 30% to 40% smaller for molars (Widths > Implant Diameter - Cantilever Effect - Bending (Widths > Implant Diameter - Cantilever Effect - Bending Effect)Effect)

• Narrow Table - More Axial, Less non-AxialNarrow Table - More Axial, Less non-Axial

• Reduced Cuspal Inclination - Less Bending forces, more axialReduced Cuspal Inclination - Less Bending forces, more axial

• Occlusal Material - Material with high modulus of elasticityOcclusal Material - Material with high modulus of elasticity

• Night Guard - ParafunctionNight Guard - Parafunction

Single UnitSingle Unit

• Avoid excursive guidance Avoid excursive guidance

• Increased proximal contactIncreased proximal contact

Multiple Unit - AnteriorMultiple Unit - Anterior

• Light contact in maximum intercuspation (30 μm)Light contact in maximum intercuspation (30 μm)

• Flatten vertical and horizontal overlap and Flatten vertical and horizontal overlap and protrusive guidance to reduce lateral forcesprotrusive guidance to reduce lateral forces

• Selective excursive guidance for best Selective excursive guidance for best biomechanical abutment distributionbiomechanical abutment distribution

Multiple Unit - PosteriorMultiple Unit - Posterior

• Excursive guidance on well-supported anterior Excursive guidance on well-supported anterior natural teeth with posterior teeth disclusion in natural teeth with posterior teeth disclusion in eccentric movementseccentric movements

• Canine protected or mutually protected occlusion Canine protected or mutually protected occlusion if canine presentif canine present

• Group function occlusal scheme if canine Group function occlusal scheme if canine absent/prosthesis replacing bilateral distal absent/prosthesis replacing bilateral distal extensionextension

• Optimum abutment support for working guidanceOptimum abutment support for working guidance

Occlusion CheckOcclusion Check• Maximum Intercuspation - Contact in the Centre, Maximum Intercuspation - Contact in the Centre,

Light contact (30 μm)Light contact (30 μm)

• Firm occlusion with shim stock (8–30 μm) Firm occlusion with shim stock (8–30 μm) passing through passing through

• Anterior guidance with natural dentition, if possibleAnterior guidance with natural dentition, if possible

• No contact on lateral movements - working, non-No contact on lateral movements - working, non-workingworking

• Group Function - if no natural tooth for lateral Group Function - if no natural tooth for lateral guidanceguidance